1. Interventional Radiology in Cancer Patients C. Douglas Edmondson, M.D., FACR C. Douglas Edmondson, M.D., FACR Interventional and Diagnostic Radiologist Interventional and Diagnostic Radiologist

2. What does IR do? Diagnosis Diagnosis Primary treatment of cancer Primary treatment of cancer Treatment of cancer related complications or sequelae Treatment of cancer related complications or sequelae

3. Diagnosis Image guided biopsy Image guided biopsy Aspiration or Drainage of fluid collections Aspiration or Drainage of fluid collections

4. Examples of Bx needle

5. CT of needle in tumor

6. Fluoroscopic image of needle in lung tumor

7. Ultrasound image of needle in tumor

8. Malignant pleural fluid Malignant pleural fluid

9. Safe – T – Centesis Catheter

10. CXR before and after tap

11. Primary treatment of cancer Transcatheter chemoembolization Transcatheter chemoembolization Transcatheter gene therapy Transcatheter gene therapy Central venous access Central venous access Tumor ablation Tumor ablation SclerotherapySclerotherapy Radiofrequency ablation (RFA)Radiofrequency ablation (RFA) MicrowaveMicrowave FreezeFreeze

12. ChemoEmbo Typically in the hepatic artery for Hepatocellular Ca or susceptible metastasis. Typically in the hepatic artery for Hepatocellular Ca or susceptible metastasis. Attacks the tumor with concentrated dose of chemotherapy or radioactive beads and embolic materials to stop blood flow to starve and poison the tumor or fry it with Beta irradiation OR all of these agents. Attacks the tumor with concentrated dose of chemotherapy or radioactive beads and embolic materials to stop blood flow to starve and poison the tumor or fry it with Beta irradiation OR all of these agents.

13. Before and after angiograms

14. CT scan of embolic material in liver

15. Radiofrequency Ablation 15 -18g needle or needles placed into the tumor usually by CT guidance for best control. 15 -18g needle or needles placed into the tumor usually by CT guidance for best control. Radiofrequency applied across the field and the tumor is coagulated and “cooked” at about 110 degrees. Radiofrequency applied across the field and the tumor is coagulated and “cooked” at about 110 degrees. Very promising results in many applications. Ever expanding indications. Very promising results in many applications. Ever expanding indications.

16. RFA needle

17. CT of RFA in Place

18. Before and After CT Scans of renal cell carcinoma

19. Treatment of Cancer related complications or sequelae Pain Control Pain Control Vertebral interventions Vertebral interventions Drainage Drainage

20. Pain Control Pain usually arises from invasion especially nerve involvement. Pain usually arises from invasion especially nerve involvement. Pancreatic cancer does not respond to any conventional therapy when usually discovered. Treat the terrible pain with celiac axis ablation. Pancreatic cancer does not respond to any conventional therapy when usually discovered. Treat the terrible pain with celiac axis ablation. Other areas such as stelate ganglion in neck, spinal nerves as they leave the spinal foramina respond to image guided ablations. Other areas such as stelate ganglion in neck, spinal nerves as they leave the spinal foramina respond to image guided ablations.

21. Pancreatic Ca with Celiac axis ablation

22. Vertebroplasty/ Kyphoplasty 11 – 14 g needles placed into vertebral body and PMMA cement injected. 11 – 14 g needles placed into vertebral body and PMMA cement injected. Eliminates pain in over 80% of metastatic lesions Eliminates pain in over 80% of metastatic lesions Kills tumor with heat as cement hardens Kills tumor with heat as cement hardens Stabilizes bone? Stabilizes bone?

23. Model of needle in vertebral body

24. Needles and PMMA in the vertebra during Vertebroplasty

25. Needle and balloon in vertebra during Kyphoplasty

26. CT of PMMA in the bone

27. Drainage and bypass Biliary obstruction Biliary obstruction Ureteral obstruction Ureteral obstruction Abcess and necrotic tumor mass effect Abcess and necrotic tumor mass effect Palliative thorocentesis or paracentesis (serial taps or permanent catheter). Palliative thorocentesis or paracentesis (serial taps or permanent catheter).

28. Biliary Drain and Stent

29. Pleur-X drain

30. Summary IR can aid with diagnosis, primary treatment, management of complications and palliation of sequelae IR can aid with diagnosis, primary treatment, management of complications and palliation of sequelae IR can do many of these with equal or better success than conventional treatments IR can do many of these with equal or better success than conventional treatments IR can do many procedures cheaper and with less complications than more traditional approaches IR can do many procedures cheaper and with less complications than more traditional approaches Nearly all procedures are OP and with local anesthetic and IVCS. Nearly all procedures are OP and with local anesthetic and IVCS. Future procedures are on the bright horizon of IR Future procedures are on the bright horizon of IR